Abstract: PO1447
Mitragyna speciosa (Kratom)-Induced Hyperkalemia
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 1
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Torres Ortiz, Aldo E., Ochsner Health System, New Orleans, Louisiana, United States
- Alqudsi, Muhannad, Ochsner Health System, New Orleans, Louisiana, United States
Group or Team Name
- Ochsner Nephrology
Introduction
Kratom is a non-controlled herbal supplement that has been used for its opioid-like effects. Case reports of different organ toxicities from Kratom have been reported in the literature. However, little is known regarding its effects on potassium (K) homeostasis. We present here the first case-report of kratom-induced hyperkalemia.
Case Description
A 61 yo male with a history of degenerative disc disease and hyperlipidemia, referred to nephrology clinic for unexplained hyperkalemia for the past 2 months. He was asymptomatic. His only home medication was rosuvastatin. Serum (K) was elevated in four different occasions with 5.8 mmol/L being the highest (non-hemolyzed samples). He denied NSAID or antibiotic use, smoking, alcohol intake, illicit drug abuse, sickness, or high (K) diet intake. No family history of renal diseases. Physical exam was unremarkable with a blood pressure of 124/76 mm Hg without orthostatic changes. Serum creatinine (Cr) was 0.8 mg/dL, eGFR >60 mL/min, plasma aldosterone was 3.6 ng/dL, rennin activity was 0.88, urine (K) was 14 mmol/L and urine Cr was 16 mg/dL, (K) fractional excretion was 15%, sodium of 141 mmol/L, CO2 33 mmol/L and the rest of the electrolytes were normal. TSH, CPK, AM cortisol, and WBC were within normal limits and he had no hematuria or proteinuria. Kidney ultrasound was normal. Upon re-interrogation, patient admitted taking daily Kratom for recreational purposes for the past 4 months as herbal supplement. A repeat blood chemistry 4 weeks after patient confirmed abstinence from Kratom, revealed normalization of (K) down to 4.6 mmol/L.
Discussion
Mitragyna speciose (Kratom) is a herbal supplement with potential abuse due to its opioid-like properties. Our patient had hyperkalemia unexplained by low renal clearance, adrenal insufficiency, medication use, or other etiologies. A study in cultured heart cells revealed a blocking effect of the cardiac (K) inward rectifier channels (Kir 2.1) by Mitragynine causing prolonged QT interval arrhythmia. Kir family does exist along the nephron with little known about Kir 2.1. Whether Kratom has effect on renal Kir 2.1, or other Kir channels is yet to be further studied. This case-report serves to highlight the importance of the identification of lesser-known supplements with potential abuse that can cause life-threatening side-effects.